Skip over navigation

End User Manual for the Noridian Medicare Portal

Eligibility

View a beneficiary's Medicare eligibility: Part A, Part B, Managed Care Organization (MCO) and Health Maintenance Organization (HMO), Medicare Secondary Payer (MSP), Home Health, Hospice, End Stage Renal Disease (ESRD), and Preventive Services.

When entering information into the inquiry screens in the portal, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose Tax Identification Number (TIN) or Social Security Number (SSN), National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination under Provider/Supplier Details
  • Complete mandatory fields (Health Insurance Claim Number (HICN) and Last Name) and enter beneficiary's first name and/or date of birth. The name must be entered as it states on beneficiary's Medicare card. Complete optional details to narrow  search

If a specific date of service is in question, enter the date(s) in the From Date and To Date fields. Otherwise, the beneficiary's eligibility will display for the current date.

Eligibility Benefits Inquiry screen is displayed.

Response
The HIPAA Eligibility Transaction System (HETS) is considered the authoritative source for beneficiary Part A and B effective and termination, demographic, MCO and HMO, and ESRD data. For CMS purposes, authoritative source means the data originates here and is shared with other systems. View more information on HETS on the CMS website This link will take you to an external website.

The eligibility response screen is displayed.

Each tab provides specific information.

Field Name

Description

Eligibility

  • Part A and B effective and termination dates
  • Deductible remaining
  • Ineligible Period (Due to classified as unlawfully present, deported or incarcerated)
  • Beneficiary address
  • Occupational, physical, and speech therapy
  • Blood deductible

Managed Care Organization (MCO) and Health Maintenance Organization (HMO)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • MCO Plan Type
  • MCO Bill Option Code
  • Address

Medicare Secondary Payer (MSP)

  • Insurer name
  • Policy number
  • Effective and termination dates
  • Insurer type
  • Address

Home Health Episode History (HHEH)

  • Payer name and ID
  • Provider number
  • Episode start and end date
  • Earliest and latest billing dates

Hospice

  • Episode effective and termination dates
  • Provider number

Hospital

  • Earliest and latest billing dates
  • Deductible remaining
  • Full days remaining
  • Lifetime reserve days remaining
  • Lifetime Psychiatric remaining and base days
  • Copayment days remaining
  • Copayment amount remaining

Skilled Nursing Facility (SNF)

  • Earliest and latest billing dates
  • Days remaining
  • Copayment days remaining
  • Copayment amount remaining

End Stage Renal Disease (ESRD)

  • Effective date
  • Benefit type

Preventive

  • Smoking cessation benefit information
  • Preventive services benefit information
  • HCPCS code/Description/next eligibility date

 

Preventive Services CPT/HCPS

  • 77057
  • 80061
  • 82270-26
  • 82270-TC
  • 82465
  • 82947
  • 82950
  • 82951
  • 83718
  • 84478
  • G0102
  • G0101-26
  • G0101-TC
  • G0103-26
  • G0103-TC
  • G0104
  • G0105
  • G0106
  • G0117
  • G0118
  • G0120
  • G0121
  • G0123
  • G0143
  • G0144
  • G0145
  • G0147
  • G0148
  • G0202
  • G0328-26
  • G0328-TC
  • G0389
  • G0402
  • G0403
  • G0404-TC
  • G0405-26
  • G0438-26
  • G0439-26
  • G0444
  • G0445
  • G0446
  • G0447
  • P3000
  • Q0091-26
  • Q0091-TC 

Claim Status

View the status of claims, view Medical Review comments and initiate a redetermination on finalized claims.

When entering information into the inquiry screens, copy and paste functionality may cause extra spaces to be entered. In this case, the portal will state the beneficiary information is invalid. Ensure no extra spaces are entered.

Inquiry

  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Complete mandatory fields in Beneficiary Details section. Complete optional fields to narrow the search

Entering a date of service is suggested to narrow the number of results.

Claim Status Inquiry screen is displayed.

Response

Select the "View Claim" link to receive additional claim information.

Claim Status Results page is displayed.

Information received should match the Interactive Voice Response (IVR) system. Consult the Provider Contact Center if information returned is not as expected. 

Effective March 24, 2016, all diagnoses submitted on a claim will display.  Diagnosis codes indicated as the primary diagnosis per line item on a claim will also display. The admitting diagnosis will also display if it was entered on the claim.

Claim Status Response with Claim Diagnosis Code and Position Details

The following table provides the field name and the description of the field.

Field Name

Description

Document Control Number (DCN)

  • Unique number assigned to claim at time received by contractor
  • Used to track and monitor claim

Status

Status of claim, e.g. finalized or pending

Billed Amount

Total charges submitted

Finalized Date

Date when claim completed the adjudication process

Provider Paid Amount

Total amount paid to provider

Bill Type

Type of bill

Receipt Date

Date claim was received

MSP Indicator

  • "Y" indicates Medicare is secondary payer
  • "N" indicates Medicare is primary payer

Crossover Indicator

  • "Y" indicates claim is a crossover claim
  • "N" indicates claim is not a crossover claim

Crossover claims are automatic electronic transfer of payment information on finalized claims to supplemental insurance companies and Medicaid that have signed agreements

Last Worked Date

Date the last time claim was examined

Check/EFT#

  • Number on check issued for payment
  • If Electronic Funds Transfer (EFT) was used for payment, this field displays the trace number

Noncovered Charges

Charges not covered by Medicare, Medicaid or private health insurance

Location

Describes queue where claim is currently situated and any action that needs to be performed

Line

Service line number of the claim

From DOS

Beginning date of service (DOS) for the claim billing period

To DOS

End date of service for the claim billing period

CPT

Current Procedural Terminology (CPT) codes

Modifier

Code that adds specification to HCPCS categorization

Diagnosis Code

  • First code displayed is ICD-9-CM code describing principal diagnosis
  • Remaining codes correspond to additional conditions that coexisted

Allowed Amount

Total amount allowed for the service line

Contractual Amount

Indicates adjustment resulting from a contractual agreement between the payer and payee or a regulatory requirement

Patient Resp.

Represents adjustment amount that is billed to the beneficiary

Billed Amount

Dollar amount billed for this line item

Provider Paid

Amount provider was paid

Reason Code

National administrative code set that identifies reasons for any differences or adjustments between original provider charge and payer's payment

 

Claim Processing Comments

The portal offers access to view claim processing comments if a claim had been selected for prepayment review in which Noridian requested documentation prior to making a claim decision. In the event a claim was not suspended during processing, this option will not be presented.

First, perform a Claim Status Inquiry as described above.

If the claim had a history of being reviewed for additional documentation, the portal will offer a "Noridian Comments" link in the claim header.

Claim Status Details with Noridian Comments button is displayed.

After selecting this link, the claim processing comments will be retrieved and presented at the bottom of the Claim Status details.

Claim Processing Comments screen is displayed.

Note: Protected Health Information (PHI) is not included within the Noridian examiner's comments.

There may be a rare occasion where a claim's history does not have comments associated with it; however, the portal might offer the "Noridian Comments" feature. In this situation, a message will be displayed indicating comments are not available. 

Financial Information

View pending and finalized check information issued to an NPI/PTAN combination.

Inquiry

  • Select Financial from top navigation or home page and then Payment Results tab
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details

Financial Inquiry screen is displayed.

Response

The portal provides the most recent 50 checks. 

Part A Payment Results screen is displayed.

Appeals Status Inquiry

Noridian processes reopening and redetermination requests within 60 days of receipt.

Inquiry
To check the status of a reopening or redetermination, select the TIN or SSN, NPI and PTAN it was submitted under and select one of the following options:

  • Option 1 – View Last 100 Appeals
  • Option 2 –  Search Existing Appeals
    • HICN
    • Appeal Status (Pending, Finalized, Additional Documentation Needed)
    • Confirmation Number

Appeal Status Inquiry screen is displayed.

Response
The results will display the confirmation number, claim number, HICN, status and date submitted. To view more information on the request select View Appeal.

Appeals Status Results screen is displayed.

A list of the submitted documentation displays. To view the document, select View Document. If additional documentation is needed, select "Add a Document."

Appeal Status Results screen with View Appeal button is displayed.

The decision letter from Appeals is available to view when the request is finalized. Letters are only available for partially favorable and denied appeals. Providers are notified of favorable decisions through the remittance advice. 

Begin New Appeal

A new appeal can also be submitted by performing a claim status inquiry and following the same steps.

Inquiry

  • Choose the TIN or SSN, NPI and PTAN combination under Provider/Supplier Details.
  • Complete the mandatory fields in the Beneficiary Details section. Complete optional fields to narrow the search.

Response

The results will display based on the criteria entered. To begin the appeal choose View Claim.

Begin New Appeal Claim Status Results screen is displayed.

Additional claim details are provided. To begin the appeal choose the Redetermination/Reopening Submission button.

Begin New Appeal Claim Status Results with Redetermination Submission button is displayed.

Redetermination Request Form

The Redetermination Request form displays. User sessions time out after 30 minutes of inactivity. Ensure all information is gathered prior to beginning the request. There are four steps to complete an appeal.

Redetermination/Reopening Details
The claim details are provided and the following questions are asked:

  • Type of Request – Redetermination or Reopening
  • Will a review of this claim cause an overpayment?
    • If answered yes, users are prompted to request a recoupment. The appeal process will not continue.

Example of the will this claim cause an overpayment question

  • Is this request the result of an overpayment?
    • If answered yes, users are asked who initiated the overpayment (Benefit Integrity, Comprehensive Error Rate Testing (CERT), Medical Review, Office of Inspector General (OIG), Recovery Auditor, Supplemental Medical Review Contractor (SMRC) or Zone Program Integrity Contractor (ZPIC)/Program Safeguard Contractor (PSC)). The Accounts Receivable (AR) Number is then required. The AR number is found on the overpayment letter from Noridian.

example of the, is this request the result of an overpayemnt, question

  • The contact person (portal user submitting the request) information is also displayed. Address information is requested on an appeal, however, this information is not required.

example of the data entry fields for a contact person

  • Next, providers will enter the claim details and an explanation as to why the appeal is being submitted and any other information is needed for the Noridian examiner.

exampe of the data entry fields for details and explainations

  • In the Claim Status Line Details section, users must check the box next to the line item the reopening or redetermination is being requested on. Note: Checking all will initiate an appeal on all lines regardless of whether they are paid or denied. This may result in a loss of further appeal rights.

example of the claim status line details screen

  • Select Next.

Electronic Signature
Users must read the attestation. If agreed, the user must type their name under "Signatory Name" and check the box next to "I have read the attestation and agree." Select the Submit button.

example of the electronic signature and attestation screen

Add Documents
To attach documentation, select the "Add Document" button. Title the document so it is recognizable when reviewing the submission and browse to locate it. Numerous documents may be added during this step. If more than one file is needed to be uploaded, select the "Add Document" button again to add another file. Once this is completed, select the Next button. If a document needs to be removed, select the Delete link in the last column.

example of the reopening redetermination add documentation screen

Confirmation
Step 4 displays a successful upload message and show the appeal information below. To add additional documents, choose the "Add Document" button on the bottom of the screen.

example of the appeals information shown after Step 4

In the event a provider has submitted a reopening/redetermination and he/she wants to delete/dismiss, a document explaining the dismissal/deletion needs to be created on the company letterhead and must contain an original, "pen and ink" true signature. This dismissal request needs to be uploaded as an attachment to the existing appeal. 

Claim-Specific Remittance Advices

View and/or print a remittance advice information for a single claim.

Inquiry

  • Select Remittance Advices from home page
  • Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Enter number of claim
    • Part A providers must also enter beneficiary's HICN

example of the claim specific remittance advice inquiry screen

Response

A copy of the claim-specific remittance advice displays. To print the claim-specific remittance advice, select "Printable Version" in the upper left corner. (The information that appears on this screen will vary depending on the claim). Definitions of remark and reason codes are provided at the bottom of the screen.

NMP Browser Compatibility

The Noridian Medicare Portal is accessible from several different web browsers; however, only certain browsers are supported. Using older browsers, non-compatible browsers, or disabling browser features such as JavaScript, may reduce functionality in website. To download the latest version of one of these browsers, use the links below.

Supported Browsers

Providers can check their browser version by going to the Help menu and selecting "About...." A screen will appear showing which browser and version is being used.

The Noridian Medicare Portal is best viewed when the display resolution is set to 1024 x 768 or above. If the settings are below 1024 x 768, additional scroll bars will be encountered.

Support Contact Information

Have the following information available: User name, company name, TIN.

  • User Security is available to assist providers with questions regarding registration, logging in to the portal, technical difficulties with availability or functionality, and password reset requests.
  • Customer Service is available to assist with any questions you may have regarding the results of the inquiry response.

Other Contacts
Providers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of the portal:

  • Beneficiary Call Center - 1-800-MEDICARE (1-800-633-4227)
  • Coordination of Benefits - 1-855-798-2627
  • Home Health - To update information, beneficiary must contact Home Health Agency
  • Social Security Administration (SSA) - To update information, beneficiary must contact SSA at 1-800-772-1213

Security Awareness Training and Recertification

  • Security Awareness Training - Security Awareness Training occurs upon the first login and will occur on a yearly basis in conjunction with the recertification. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. This training must be completed within the 45 day period in order to continue using the portal. If this training is not completed within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to complete the training. If the training is not completed within 90 days, the user's account will be deleted and the user must re-register.
  • Recertification - Portal users will be prompted to recertify accounts on a yearly basis. This recertification demonstrates the Noridian Medicare Portal account is being used by the appropriate person. The process will initiate 45 days prior to the last day of the month in which the users account was initially setup. The recertification must be completed within the 45 day period in order to continue using the portal. If the account is not recertified within the timeframe, the user's account will be disabled and the user must contact Noridian Medicare Portal Support in order to unlock it. Upon logging in again, the user will be prompted to recertify the account. If it is not recertified within 90 days, the user's account will be deleted and the user must re-register.

 

Last Updated Feb 27, 2017